Hospice services are Kentucky Medicaid Provider Type (44). To bill Kentucky Medicaid, hospice providers must be:
- Licensed in the state in which they operate. In Kentucky, hospice providers must contact the
Office of Inspector General Division of Health Care to obtain licensing.
- Enrolled as an active Medicaid provider and, if applicable, with the managed care organization (MCO) of any beneficiary it serves.
Covered Services
Hospice services are available to individuals who have a terminal diagnosis with a life expectancy of six months or less as certified by a physician. Hospice services provide care an individual needs to live as fully and comfortably as possible. Hospice also supports the individual's family as they adjust to the individual's illness and death. Hospice services are provided at home, in a nursing facility, or in an intermediate care facility for individuals with intellectual disabilities.
Hospice providers must meet the coverage provisions and requirements of
907 KAR 1:330. Services must be performed within the scope of practice for any provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant Kentucky Medicaid regulations and the requirements of any MCO in which they participate. All services must be medically necessary.
Eligibility
Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based
KYHealth-Net System.
To receive hospice services, individuals must complete the
MAP-374 - Election of Medicaid Hospice Benefit Form. Individuals receive treatment for conditions related to their terminal illness by their hospice provider. Individuals younger than 21 are eligible to receive curative treatment for their terminal illness concurrently with hospice services. If an individual is eligible for both Medicare and Medicaid, known as dual eligibility, the hospice benefit must be elected and revoked simultaneously under both programs.
Benefits
Hospice benefits consist of two 90-day periods. An additional 60 days of hospice benefits are covered until revocation or termination for other reasons such as ineligibility or death.
- Send non-institutional MAP-374, MAP-375, MAP-376, MAP-378, and MAP-403 forms to DMS via
email.
- Mail or fax the MAP-377, MAP-383, MAP-384, and MAP-397 to:
Carewise Health
9200 Shelbyville Road, Suite 800
Louisville, Kentucky 40222
Fax: (800) 292-2392, option 9
Reimbursement
Hospice services are reimbursed per 907 KAR 1:340.
Find Current Fee and Rate Schedules
Find Archived Fee and Rate Schedules
Duplication of Service
Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered, during the same time.
Prior Authorizations
Some Hospice services may require prior authorization. Each MCO provides prior authorization for its beneficiaries. Gainwell Technologies provides prior authorizations for fee-for-service (FFS) beneficiaries. For more information, visit Prior Authorizations.
Claims Submission
Each MCO processes its own claims.
Kentucky Medicaid contracts with Gainwell Technologies to process the Kentucky Medicaid FFS claims. For more information, visit KYHealth-Net.
Find FFS Provider Billing Instructions
Coding
Kentucky Medicaid requires providers to bill on a CMS-1500 claim form utilizing the following code types where applicable:
- Current Procedure Terminology (CPT) codes, regulated by the American Medical Association (AMA).
- Healthcare Common Procedure Coding System (HCPCS) codes, regulated by the Centers for Medicare and Medicaid Services (CMS).
- Current Dental Terminology (CDT) codes, regulated by the American Dental Association (ADA).
- International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes, maintained by the Centers for Disease Control & Prevention (CDC) and the National Center for Health Statistics (NCHS).
Kentucky Medicaid uses the Medicare National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits, the Medicaid Medically Unlikely Edits (MUEs), and the McKesson Claim Check System to verify codes mutually exclusive or incidental.
Claim Appeals
Appeal requests for denied FFS claims must be submitted to Gainwell Technologies. The request must include the Provider Inquiry Form, reason for the appeal, and a hard copy claim.
Please refer to the member's MCO if appealing an MCO claim.
Timely Filing
Claims must be received within twelve (12) months from the date the service was provided, twelve (12) months from the date retroactive eligibility was established, or six (6) months of the Medicare adjudication date if the service was billed to Medicare.
Regulations
907 KAR - Cabinet for Health and Family Services - DMS Title Page
907 KAR 1:330 - Hospice services
907 KAR 1:340 - Reimbursement for hospice services
907 KAR 3:130 - Medical necessity and clinically appropriate determination basis
KRS Chapter 216B.195 - Residential hospice facilities - automated pharmacy system
Provider Resources
MAP Forms
MAP-374 - Election of Medicaid Hospice Benefit Form
MAP-375 - Revocation of Medicaid Hospice Benefits
MAP-376 - Change of Hospice Providers
MAP-377 - Physician Certification for Medicaid Hospice Benefit Recertification
MAP-378 - Termination of Medicaid Hospice Benefits
MAP-379 - Representation Statement for Election of Hospice Benefits
MAP-383 - Other Hospital Statement Form
MAP-384 - Hospice Non-Related Drug Form
MAP-397 - Other Services Statement Form
MAP-403 - Hospice Patient Status Change
Find MAP Forms
Level of Care Information
Kentucky Level of Care System (KLOCS)
Helpful Links
Hospice Provider Summary
Find Provider Letters
Provider Inquiry Resources
If you cannot find the information you need or have additional questions, please review the Kentucky
Medicaid Contacts List to find additional support from Kentucky Medicaid.